Unique Challenges for Female Sex and Love Addicts Making Advances CAPTASA Conference 2013 Susan J. Campling RN,PsyD

Disclosure Co-Author, Making Advances Executive Director Magnolia Creek Board Member Society for the Advancement of Sexual Health

Objectives Understand current research regarding FSLA Outline best practices for FSLA Identify tools of recovery

History 2008-2009 Women’s Summit met to discuss FSLA and treatment issues Initially identified the need for an appropriate female centered assessment toll which asked questions regarding issues more often found among women Identified need for further research so the assessment was converted into a tool that was placed on Survey Monkey N= 471

Women are different then men Brains are different Socialization is different History is different Interpersonal interaction is different Addiction experience is different and treatment needs to reflect these differences Women do better when their therapist is sensitive to their attachment history, trauma and attachment needs The client must feel safe and secure and heard Resources are limited for women especially mothers and caretakers Traditional focus is often upon single issues and many programs do not want to look holistically at the patient

Neuro-attachment Factors Attachment wounds in infancy result in vulnerability to later MDD, PPTSD, schizophrenia and BPD (Roth & Sweatt, 2011) Attachment failure and neglect may be more harmful than violence or abuse (Field, Diego, Hernandex-Reif, 2016) At 8 weeks of fetal development testosterone surges alter cell growth in the communication centers of the brain. Females fetuses do not experience these changes. Female brains remain structured for social connection. Attachment is a major factor in affect regulation skills especially I females. FSLA is defined by some as “a regulation impairment due to fundamental attachment disorder”.

Environmental Social Factors Family systems- Family messages about sex, women, value, Modana Whore Mother hunger and Wounding- (attachments wounds from first love, Kelly) Trauma (Carnes) 97% of SA have emotional trauma, 81% sexual trauma, 72% physical abuse (male and female data) Schwartz and Southern found that among women in treatment, 76% had a history of sexual trauma and refusing unwanted advances, 43 substance abuse histories and 68% eating disorders (2000)

Corley and Hook 2012 Women are more likely to enter into relationships on social network sites such as Facebook and/or play social interaction games such as Second Life Women use the internet for fantasy and relationships while men use it to stimulate for masturbation Women are more likely to keep their online behaviors a secret

Women’s Sexuality Survey (Study reported by Corley and Hook 2012) 14% of women in study reported cybersex as problem Women in this group reported more time online and reported more symptoms than the addicted/no cybersex group 79.3% of that group reported frequently visiting porn/and chat rooms 57% of that group reported relying on abusive porn/fantasies to feel aroused

Women’s Sexuality Survey 70% of FSLA reported feeling degraded by their sexual behavior as opposed to 32% of non-addicted women 37% reported having faked orgasms to please partners Women who use internet for sexual purposes or have sexual fetishes report high shame because of the taboo High degree of relational difficulties Damaging relationships

Women, Technology and Social Networking Sites Internet use by men and women tend to be different Men use porn for arousal; Women use social sites and games for erotic connection Women are more likely to go meet someone they “met on-line” Internet information shapes attitudes, values, behaviors Raises the question what is normal? Offers perception of “safety” and “anonymity” Creates Conversation: Facebook, My Space, etc.

Women, Technology and Social Networking Sites Find Dates: Match, plentyoffish, eHarmony, OkCupid, True, DateHookUp, FriendFinder, Jdate Creates Secrets: Ashley Madison, Married Secrets, lonelyhousewives, Xanga Provides Opportunities for Interactive Sex (teledildonics / cyberdildonics): Fleshlight, Sinulator, realtouch US Facebook crime statistic are difficult to track however the UK reports a 7000% increase in crimes associated with Facebook

Women and Eating Disorders Generally, patterns of drug use, eating disordered behavior and sexual behaviors all follow similar pathways, arousal, satiety, or mixed Fantasy is also a key issue in ED with SA “No one will love me unless I am … My body must be right. He will not want me if I am not thin/pretty/have large breasts/… Similar self talk in SA and ED

Case Example I- Mary 25 year old, single woman Restrictive eating disorder behaviors since age 13 Covert incest. Early exposure to pornography (age 5) Began cocaine 4 years ago while in college to lose weight Dropped out of college due to cocaine; Sex worker (real & virtual) Perfectionistic high achieving in school, very smart S+M sexuality, hypersexual- masturbates 3-4 times per day

Case Example II- Jean 30 year old single woman Restricting and purging ED Texting, sexting, compulsive phone use Cosmetic surgeries ($ by partner) Alcoholic Parents knew she was going to sex cubs with her boyfriend and condoned it. Trauma bonded in romantic relationships- “best friend, treats me wonderfully”. (He raped her, drugged her and watched her have sex with other women. Acts as her pimp. Sexual sadist)

Treating female SLAs is no easy task. Now What? Treating female SLAs is no easy task. The therapist must be: Sensitive Supportive Skilled SAFE

Treatment Differences Tasks are critical to healing damaged brain chemistry and maintaining healthy relationship skills. Men and women have different brains and approach tasks differently. Females respond better and are more likely to complete tasks in the therapy room; she wants to connect (not just complete a task) and will use both sides of her brain. Giving her “just homework to do” makes it likely she will feel dismissed and increase her shame so she can’t do the task.

Tools for the Life History Genogram Art Dance Music Poetry Narrative History Trauma Egg / Timeline Journaling Psychodrama Descansos (Pinkola-Estes, 1992) Teletherapy & Parallel Process

Comprehensive Life History Telling the Story Gives Voice Provides a vehicle for change Helps clients process feelings, break through denial and explore grief Challenge distorted thoughts and core beliefs Transform suffering into meaning Feel connection with therapist Carol Gilligan

Comprehensive Life History Genogram / Family Map - outlines historical and current family relationships, including information about addictions or dysfunctions. Gather information quickly Identify players Recognize attachment wounds Find support networks

Addressing Shame Narrative therapy begins the process of “shame resilience” and story-claiming. Who do you become when you’re backed in to a shame corner? How do you protect yourself? Who do you call to work through the mean-nasties or the cry-n-hides or the people-pleasing? What’s the most courageous thing you could do for yourself when you feel small and hurt? Brene Brown 2010

Worthiness “I realized that only ONE thing separated the men and women who felt a deep sense of love and belonging from the people who seem to be struggling for it. That one thing is the belief in their worthiness. It’s as simple and as complicated as this: IF we want to fully experience love and belonging, we must believe that we are “worthy” of love and belonging.” Brene Brown (2010)

Tools of Recovery Complete a comprehensive Life History. 12-Step support (SA, SAA, SLAA, SCA, CSA, SRA, RCA) - including getting a sponsor, working the Steps and connecting with others / a sponsor, daily. Disclosure as necessary. Reading recovery literature. Eat, pray self-love Anger work Medication .

Tools of Recovery 30 Tasks (Carnes model) - including assessments and arousal template. Do this in session if needed. Recovery Circles - identify bottom-lines (sobriety), limits, triggers, rituals and self-care boundaries. Celibacy or Abstinence Contract - including no dating or participating in any erotic relationships. Teletherapy. Dating timeline (Katehakis) and Healthy Sexuality Model (Manley), and…

12-Step Support Difference in “S” Group recovery for women Women among women - friend or foe? Finding a sponsor - learning accountability Working the steps What’s God got to do with it?

Tools of Recovery

Making Advances A Comprehensive Guide for Treating Female Sex and Love Addicts Edited by Marnie C. Ferree Writers: Susan J. Campling Robin Cato M. Deborah Corley Marnie C. Ferree Linda Hudson Alexandra Katehakis Kelly McDaniel Anna Valenti-Anderson Jill Vermeire Sonnee Weedn All proceeds benefit the Society for the Advancement of Sexual Health www.sash.net/makingadvances